From Implantable CGM to Continuous Ketone Monitoring: How New Technology Is Transforming Diabetes Care

In an interview with Pharmacy Times, Diana Isaacs, PharmD, BCACP, BC-ADM, CDCES, FADCES, FCCP, endocrine pharmacist at Cleveland Clinic Diabetes Center, discussed key topics covered at the 2026 Diabetes Day of Education, highlighting how the expanding integration of continuous glucose monitoring (CGM) with automated insulin delivery systems, including the newly integrated implantable EverSense 365, is giving patients more choices than ever before.

Isaacs noted that the 2026 America Diabetes Association (ADA) Standards of Care now recommend automated insulin delivery (AID) systems not only for patients requiring mealtime insulin but also for those with type 2 diabetes on basal insulin who are not meeting their goals, reflecting a significant broadening of who should be offered these technologies. She also discussed the anticipated arrival of a dual glucose-ketone monitor, identifying patients with type 1 diabetes, any history of diabetic ketoacidosis (DKA), and those taking SGLT2 inhibitors as populations who stand to benefit most from continuous ketone monitoring. Isaacs concluded with a practical call to action for pharmacists and pharmacy technicians: simply talking to patients about CGM, explaining its benefits, and empowering them to advocate for access with their prescribers can make a meaningful difference.

Pharmacy Times: With the transition to newer CGM systems and their integration with automated insulin delivery, what do you consider the most impactful advancement for patients in 2026?

Diana Isaacs, PharmD, BCACP, BC-ADM, CDCES, FADCES, FCCP: In 2026, I think the most impactful advancement for patients will have been the wide integration of CGM with AID. We have more choices than ever. Many of the systems will work with both Libre and Dexcom, offering people choice—they can switch if they don’t like their current CGM. What’s also really exciting this year is the implantable CGM, the EverSense 365. It became integrated and is now working with the first AID system, the Twist, and we hope to see it continue to work with even more systems so that ultimately people have the greatest possible choice. The other significant development in 2026 is that the ADA Standards of Care now recommend AID systems for anyone who needs mealtime insulin. New this year, they also recommend that someone with type 2 diabetes who is on basal insulin and not meeting their goals should also consider AID systems. When you think about how many people this could impact, it’s really huge. It shows the value of offering these systems, because by working with CGM, they can increase and decrease background insulin to really help people reach their A1c and time-in-range goals.

Pharmacy Times: Where do you see continuous ketone monitoring fitting into everyday diabetes management, and which patient populations stand to benefit most?

Isaacs: Continuous ketone monitoring is really exciting. We will hopefully see a dual glucose-ketone monitor come out later this year. When we think about who would benefit the most, I think anyone with type 1 diabetes ideally should have this technology, because people with type 1 diabetes do not make their own insulin, so there is always an underlying risk of going into diabetic ketoacidosis, or DKA. Beyond that population, which is where we would naturally start, we do know that some people with type 2 or other forms of diabetes sometimes also experience DKA. So I think anyone with any history of DKA would also be a perfect candidate for this technology. We can also consider expanding access to people taking SGLT2 inhibitors, who carry a risk of euglycemic DKA as well.

Pharmacy Times: What is one practical strategy pharmacists and pharmacy technicians can implement today to help more patients gain access to the CGM technology they need?

Isaacs: I would say just talk to your patients. Ask them if they have heard of CGM and let them know about the benefits so that they can have an informed conversation with their prescriber. A key point is that the ADA Standards of Care recommend CGM for any person with diabetes who could benefit from the technology, which is really a wide array of people. Simply mentioning it and making sure patients are aware empowers them to advocate for access to this technology.